Sanford Jackson Hospital — price list
← Hospital overviewVerified from Sanford Jackson Hospital’s published price file
Includes cash prices, list prices, insurance-negotiated rates. Open any row for plan-level negotiated rates. This is public hospital price transparency data, not a guaranteed estimate of your bill.
Showing the first 1,500 prices from a large file. Search a procedure or code below to narrow the list.
How to read these columns
- List
- The hospital’s full undiscounted (gross) charge — rarely what anyone actually pays.
- Cash
- The discounted self-pay price for paying directly, without insurance.
- Negotiated
- Rates agreed with insurers; open a row for plan-level detail. Your share depends on your benefits.
These are the hospital’s published reference prices, not a personalized estimate of your bill.
1,500 prices shown.
| Service | Code | List price | Cash price | Negotiated range | Allowed (median) | |
|---|---|---|---|---|---|---|
| ,Insulin Aspart Soln Pen-injector 100 Unit/ML,Insulin Aspart Soln Cartridge 100 Unit/ML Inpatient | 0250 RC | $54.34 | $43.48 | $29.12 – $51.41 | — | |
| 17 hydroxypregnenolone 84143.900 Inpatient | 84143 CPT | $87.00 | $69.60 | $46.61 – $82.30 | — | |
| 5 hiaa (5 hydroxy) random urine 83497.901 Inpatient | 83497 CPT | $108 | $86.40 | $57.87 – $102 | — | |
| A1at phenotype so 82104.901 Inpatient | 82104 CPT | $278 | $222 | $149 – $263 | — | |
| Abatacept For IV Soln 250 MG Inpatient | J0129 HCPCS | $2,600 | $2,080 | $1,393 – $2,459 | — | |
| Acetaminophen IV Soln 10 MG/ML Inpatient | J0134 HCPCS | $124 | $99.59 | $66.70 – $118 | — | |
| Acetaminophen IV Soln 10 MG/ML Inpatient | J0136 HCPCS | $198 | $158 | $106 – $187 | — | |
| Acetaminophen IV Soln 10 MG/ML Inpatient | J0137 HCPCS | $153 | $122 | $81.75 – $144 | — | |
| Acetaminophen Liquid 160 MG/5ML Inpatient | J3490 HCPCS | $4.77 | $3.82 | $2.56 – $4.51 | — | |
| Acetaminophen Suppos 120 MG Inpatient | 0250 RC | $1.50 | $1.20 | $0.80 – $1.42 | — | |
| Acetaminophen Suppos 325 MG Inpatient | 0250 RC | $5.95 | $4.76 | $3.19 – $5.63 | — | |
| Acetaminophen Suppos 650 MG Inpatient | 0250 RC | $1.50 | $1.20 | $0.80 – $1.42 | — | |
| Acetaminophen Susp 160 MG/5ML Inpatient | 0250 RC | $8.79 | $7.04 | $4.71 – $8.32 | — | |
| Acetaminophen Tab 325 MG Inpatient | J3490 HCPCS | $1.75 | $1.40 | $0.94 – $1.66 | — | |
| Acetaminophen Tab 500 MG Inpatient | J3490 HCPCS | $1.75 | $1.40 | $0.94 – $1.66 | — | |
| Acetaminophen w/ Codeine Tab 300-30 MG Inpatient | 0250 RC | $16.42 | $13.14 | $8.80 – $15.53 | — | |
| Acetic Acid Irrigation Soln 0.25% Inpatient | 0250 RC | $17.90 | $14.32 | $9.59 – $16.93 | — | |
| Acetylcysteine Cap 600 MG Inpatient | 0250 RC | $1.50 | $1.20 | $0.80 – $1.42 | — | |
| Acetylcysteine Inhal Soln 20% Inpatient | 0250 RC | $21.75 | $17.40 | $11.65 – $20.58 | — | |
| Acetylcysteine Inhal Soln 20% Inpatient | J7608 HCPCS | $21.75 | $17.40 | $11.65 – $20.58 | — | |
| Acetylcysteine Inj 200 MG/ML Inpatient | J0132 HCPCS | $114 | $90.84 | $60.84 – $107 | — | |
| Activated protein c apc resistance assay 85307 Inpatient | 85307 CPT | $378 | $302 | $203 – $358 | — | |
| Acute hepatitis panel 80074 Inpatient | 80074 CPT | $411 | $329 | $220 – $389 | — | |
| Acyclovir Sodium IV Soln 50 MG/ML Inpatient | J0133 HCPCS | $77.76 | $62.21 | $41.66 – $73.56 | — | |
| Acyclovir Tab 400 MG Inpatient | 0250 RC | $1.50 | $1.20 | $0.80 – $1.42 | — | |
| Adenoidectomy Inpatient | 0360 RC | $4,283 | $3,426 | $2,295 – $4,052 | — | |
| Adenoidectomy wtubes Inpatient | 0360 RC | $5,144 | $4,115 | $2,756 – $4,866 | — | |
| Adenosine IV Soln 12 MG/4ML Inpatient | J0153 HCPCS | $76.98 | $61.59 | $41.25 – $72.82 | — | |
| Adenosine IV Soln 6 MG/2ML Inpatient | J0153 HCPCS | $76.28 | $61.03 | $40.87 – $72.16 | — | |
| Adenovirus 87260 Inpatient | 87260 CPT | $146 | $117 | $78.23 – $138 | — |